New humanitarian discount policy increases access to expensive pneumonia vaccines

MSF uses new program to conduct vaccination campaign for refugee children in Greece

MSF doctor Stefanos Tsallas vaccinates a refugee child in Greece against pneumonia.
GREECE 2019 © Anna Pantelia/MSF
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NEW YORK/ATHENS, APRIL 12, 2019—Refugee children on the Greek islands of Chios, Samos, and Lesvos have begun receiving pneumonia vaccinations thanks to a policy that makes the vaccine available to humanitarian organizations at a reduced price, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) Friday.

The rollout of the vaccination campaign in Greece marks the first time that the policy, known as the “Humanitarian Mechanism,” has been used in a high-income country. The vaccine will be available for about $9 per child (for the three doses needed for full immunization) for use by humanitarian organizations and United Nations agencies, though governments don’t have access to the reduced price through the “Humanitarian Mechanism.” The current price of the PCV at local pharmacies in Greece is $168 per child.

“The high price of the pneumonia vaccine has blocked children from being protected against this childhood killer even though the disease is easily preventable with a vaccine,” said Dr. Apostolos Veizis, director of MSF’s medical operational support in Athens. “It’s a landmark step that we are able to vaccinate refugee children even in a high-income country at this highly-reduced price, but we need more vaccines to be included in the ‘Humanitarian Mechanism’ and for governments hosting children in crisis to be able to access these prices, too. All children in the world should be able to get this vaccine at an affordable price.”

Pneumonia remains the single largest killer of children under five worldwide, and children living in precarious conditions—including those in refugee camps—are at a particularly high risk. Refugee children face additional barriers to vaccination. For example, countries might not have vaccination programs that include refugees, or parents might be unable to navigate difficult health care systems in their new countries.

Pharmaceutical corporations Pfizer and GSK are currently the only producers of the pneumonia vaccine, which is the most expensive product in today’s standard childhood vaccination package. In the United States, which opposes negotiating prices with pharmaceutical corporations, the list price for the vaccine is up to $540 per child. France, a high-income country that does negotiate with pharma, pays $189 for the same vaccine. Smaller countries with less negotiating power are often stuck in between; for example, Lebanon pays about $243.

Before the policy was established, the way to access the reduced price for the vaccine was through Gavi, the Vaccine Alliance, which is a donor-funded organization that helps the world’s poorest countries—but not humanitarian organizations—access newer vaccines. However, through Gavi, there are usually only enough vaccines procured to cover children born in a particular country, not those who have moved there.

The “Humanitarian Mechanism” so far has been used by organizations in several low-income countries, with MSF having used it to vaccinate children in the Central African Republic, Niger, Nigeria, South Sudan, and Syria. The mechanism is currently only being used to increase access to the pneumonia vaccine and needs to be expanded to include additional vaccines not covered by GAVI or other reduced-price programs for use in humanitarian emergencies, said MSF.

“Children caught in emergencies are among the world’s most vulnerable, yet do not routinely receive protection from life-threatening diseases,” said Suzanne Scheele, vaccines policy advisor for MSF’s Access Campaign. “The ‘Humanitarian Mechanism’ has been helpful in reaching children that were previously left unprotected from preventable, life-threatening pneumonia. We urge pharmaceutical manufacturers to make it easier for governments and treatment providers like MSF to buy vaccines at affordable prices to protect incredibly vulnerable children in urgent need of vaccination now.”

While the “Humanitarian Mechanism” has been useful in protecting children in crisis, countries at all income levels continue to struggle to access the pneumonia vaccine at an affordable price. Approximately one-third of countries globally have not been able to include the pneumonia vaccine in their standard vaccination package due to the exorbitant price charged by Pfizer and GSK.

Jordan, for instance, is grappling with high vaccine prices while faced with a refugee crisis that has made the country host to the world’s second-highest share of refugees relative to its population. While the country has introduced free immunization for all children regardless of citizenship or migration status, in reality it cannot afford costly vaccines such as this one, leaving all children in the country vulnerable to pneumococcal infection.

Since 2009, Pfizer and GSK have earned $49.1 billion in sales from the pneumonia vaccine alone. Pfizer—which is US-based—has made $43.5 billion, and GSK has made $5.6 billion from this vaccine.

“The ‘Humanitarian Mechanism’ is a stopgap solution developed essentially because pneumonia vaccine prices are too high,” Scheele said. “What will make a real difference will be when new manufacturers launch more affordable pneumonia vaccines so that children’s lives aren’t at risk due to corporate greed. We can no longer live in a world where vaccines that can protect children against killer diseases remain a luxury for so many.”

The “Humanitarian Mechanism” was jointly launched by WHO, UNICEF, MSF, and Save the Children in May 2017, following MSF’s years-long A Fair Shot campaign that resulted in Pfizer and GSK agreeing in 2016 to lower the price of their pneumonia vaccines for children caught in humanitarian emergencies. However, the mechanism is limited to civil society organizations and UN agencies and does not include use by governments responding to emergencies.